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GIT > Liver > Flashcards

Liver Flashcards

(36 cards)

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1
Q

How does the liver affect drugs

A

Change from lipid soluble to water soluble in the intraceullar space

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2
Q

What factors affect the hepatic uptake of drugs

A
  1. Protein binding
  2. Blood flow
  3. Specific receptor or transport protein
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3
Q

How does protein binding affect hepatic uptake of drugs

A

Weak or strong bound proteins

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4
Q

How does blood flow influence hepatic uptake of drugs

A

Reduced blood flow in cirrhosis

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5
Q

What are factors influencing the activity of drug metabolizing enzymes

A
  1. Genetic
  2. Age
  3. Drugs
  4. Disease
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6
Q

What are the genetic factors influencing the activity of drug metabolizing enzymes

A

Slow and fast acetylation of INH

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7
Q

How does age influence the activity of drug metabolizing enzymes

A
  1. Decreased blood flow to liver
  2. Decreased liver mass
  3. Pseudo capilizarization
  4. Decline in hepatic oxygenation
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8
Q

What drugs affect the activity of drug metabolizing enzymes

A

Warfarin
Phenytoin

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9
Q

How does sulphonamides affect the liver

A

Increased load

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10
Q

How does anabolic steroids affect the liver

A

Disordered metabolism

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11
Q

How does INH affect the liver

A

Hepatitis

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12
Q

How does halothane affect the liver

A

Hepatitis

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13
Q
A
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14
Q

How does phenothiazine affect the liver

A

Cholestatic

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15
Q

What are the subtype of drug induced liver injury

A
  1. Hepatocellular
  2. Cholestatic
  3. Mixed
  4. Granulomatous
  5. Vascular
  6. Steatosis
  7. Tumor
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16
Q

What are different types of hepatotoxins

Study These Flashcards
A
  1. Carbon tetracholride
  2. Tetracycline
  3. Aminita phalloides
  4. Cytotoxic drugs
  5. Methotrexate
  6. Paracetamol
  7. Arsenic
17
Q

What are clinical features of hepatotoxins

Study These Flashcards
A
  1. Anorexia, n +V
  2. Hepatomegally
  3. Jaundice
18
Q

What are signs of severe toxic hepatitis

Study These Flashcards
A
  1. Intense abdominal pain
  2. Haematemesis
  3. Rapid decrease in liver size
  4. Ascites, oedema
  5. Bleeding tendency
  6. Coma
  7. Ureamia
19
Q

What are the treatments for toxic hepatitis

Study These Flashcards
A

Gastric lavage
Antidotes

20
Q

What is the antidote for paracetamol

Study These Flashcards
A

N acetylcystine

21
Q

When to take bloods after a paracetamol overdose

Study These Flashcards
A

Atleast 4 hours

22
Q

What are the toxic levels of paracetamol at 4, 8, 12 and 16 hours after ingestion

Study These Flashcards
A

4 >1000
8 >550
12 >250
16 >150

23
Q

What is the treatment guidelines for NAC in paracetamol overdose

Study These Flashcards
A

*150ml/kg IVI in 200ml 5% dextrose over 60 min

*50mg /kg in 500ml 5% dextrose over 4 hours

*100ml/kg in 1L 5% dextrose over 16 hours

24
Q

What is the most important electrolyte you should monitor when administering NAC in paracetamol overdose

Study These Flashcards
A

K+ prone to hypokalaemia

25
What is the alternative drug for paracetamol overdose
Carboscysteine 3ml/kg PO 4hrly for 24 hours
26
What are some examples of drug inducers P450 activity
1. Ethanol (chronic) 2. Barbiturates 3. Oral contraceptives 4. Cigarette smoke 5. Dagga 6. Phenytoin 7. Rifampin 8. Isoniazid
27
What are P450 inhibitors examples
1. Ethanol (acute) 2. Cimetidine 3. Ketoconazole 4. Allopurinol 5. Amiodarone 6. Isoniazid
28
What are the primary drug mechanisms of impaired drug metabolism
1 reduced cell mass/function 2. Reduced drug delivery 3. Reduced bile flow
29
What are secondary mechanisms of impaired drug metabolism in liver disease
1. Decreased protein binding 2. Decreased renal clearance 3. Malnutrition 4. Endocrine changes
30
What are examples of drug induced fatty liver (macrovesivular)
1. Methotrexate 2. Allopurinol 3. Halothane 4. Isoniazid 5. A methyl dopa
31
What are examples of drug included fatty liver (microvesicular)
1.Tetracycline 2. Valroic acid 3. Ibuprofen 4. Pirprofen 5. Amineptine 6. Salicylic acid 7. Tamoxifen
32
What are the 3 types of drug included liber injury
1. Direct hepatotoxicity 2. Indirect hepatoxixity 3. Idiosyncratic hepatotoxicity
33
What is direct hepatotoxicity
Direct liver injury caused by hepatotoxic drugs
34
What is indirect hepatoxixity
Secondary liver injury due to drug effects on the immune system
35
What is idiosyncratic hepatotoxicity
Secondary liver injury caused by an abnormal immune reaction to the drug
36
How to diagnose DILI
1. Raised or normal AST, ALT, ALP 2. Normal or raised bilirubin 3. Normal or raised albumin 5. Normal or increased INR 6. Liver ultrasound shows cirrhosis, biliary obstruction

GIT (1 decks)

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